[ARTICLE] Effect of a Caregiver’s Education Program on Stroke Rehabilitation – Full Text

ObjectiveTo evaluate effects of caregiver’s education program on their satisfaction, as well as patient functional recovery, performed in addition to daily conventional rehabilitation treatment.

MethodsThree hundred eleven subjects diagnosed with first-onset stroke and transferred to the Department of Physical Medicine and Rehabilitation of Inha University Hospital were surveyed. In 2015, caregivers attended an education program for acute and subacute stroke patients. Patients who received an additional rehabilitation therapy were assigned to the experimental group (n=81), whereas the control group (n=100) consisted of transfer cases in 2014 with only conventional treatment. The experimental group was classified by severity using the Korean version of the National Institutes of Health Stroke Scale (K-NIHSS), which was administered to all 181 subjects, in addition to, the Korean version of the Mini Mental Status Examination (K-MMSE), a Modified Barthel Index (K-MBI), and the Berg Balance Scale (K-BBS). Caregiver satisfaction and burden before and after education programs were assessed using the Canadian Occupational Performance Measure (COPM), as well as family burden and caregiver burnout scales.

ResultsNo significant intergroup difference was observed between initial K-NIHSS, K-MMSE, K-BBS, K-MBI scores, and times from admission to transfer. Those with moderate or severe strokes under the experimental condition showed a more significant improvement than the control group as determined by the K-NIHSS and K-BBS, as well as tendential K-MMSE and K-MBI score increases. Satisfaction was significantly greater for family members and formal caregivers of patients with strokes of moderate severity in the experimental group.

ConclusionThe caregiver’s education program for stroke subjects had a positive outcome on patients’ functional improvement and caregiver satisfaction. The authors believe that the additional rehabilitation therapy with the education program aids patients to achieve functional improvements for an optimal return to social life.

INTRODUCTION

Stroke is prevalent among the elderly and a main cause of severe chronic disabilities. The Korea National Health Insurance Service reported that cerebrovascular disease is the third most common disease following cancer and cardiac disease (48.2 persons per 100,000 of the population) in 2014, but mortality rates due to cerebrovascular disease were lower than in 2004. Regarding the latter, acute management including medical treatment (e.g., recombinant tissue plasminogen) and organized interdisciplinary care has improved, and mortality rates decreased accordingly [1]. However, despite such relatively successful acute medical management, the majority of stroke patients suffer life-long disability [2]. In a previous long-term study, it was reported that 25%–74% of stroke survivors required assistance to perform activities of daily living (ADL) including feeding, self-care, and mobility [3].

Considering the prevalence of cerebrovascular disease and residual disability, in stroke, interdisciplinary comprehensive rehabilitation intervention is considered a major management modality for poststroke care, so this type of intervention has increasingly been asked for [4]. The effect of interdisciplinary comprehensive rehabilitation is strengthened by reiteration and intenseness (high-intensive practice and repetitive task oriented training) [4, 5]. However, in Korea, a 5-day work week system has been adopted and most hospitals cannot perform rehabilitation therapy at weekends.

Previous reviews have reported that additional exercise programs by therapists at weekends could improve functional recoveries after stroke [6, 7]. Thus, it stood to reason that additional rehabilitation therapy based on a caregiver’s education program could improve functional recovery after stroke. Accordingly, the purpose of this study was to evaluate the effects of rehabilitation therapy on patients’ functional recovery by caregivers and the latter group’s satisfaction, in addition to daily conventional rehabilitation treatment.

Table 1. The education program of caregivers for physical and occupational activities

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